title: Adrenocortical carcinoma initially presenting with hypokalemia and hypertension mimicking hyperaldosteronism: a case report.
abstract: BACKGROUND
  Adrenocortical carcinoma is a rare malignancy and rare cause of Cushing's syndrome.
  
  
  METHODS
  A 65-year-old seemingly well male patient was referred to our clinic under the suspicion of hyperaldosteronism due to hypertension combined with hypokalemia. However, his serum aldosterone and plasma renin activity were within normal limits. Instead, Cushing's syndrome was diagnosed by elevated urine free cortisol and a non-suppressible dexamethasone test. Abdominal computed tomography showed a 7.8 × 4.8 cm mass lesion at the right adrenal gland with liver invasion. Etomidate infusion was performed to reduce his cortisol level before the patient received a right adrenalectomy and liver wedge resection. The pathology report showed adrenocortical carcinoma with liver and lymph node metastasis. According to the European Network for the Study of Adrenal Tumors (ENSAT) staging system, the tumor was classified as T4N1M1, stage IV. Recurrent hypercortisolism was found shortly after surgery. The patient died of Fournier's gangrene with septic shock on the 59th day after diagnosis.
  
  
  CONCLUSIONS
  We report a case of rapidly progressive stage IV adrenocortical carcinoma with initial presentations of hypokaelmia and hypertension, mimicking hyperaldosteronism.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, No, 201, Sec, 2, Shih-Pai Rd, Taipei 112, Taiwan. cskuo@vghtpe.gov.tw.
authors.forename: Chun-Jui
authors.initials: CJ
authors.lastname: Huang
authors.forename: Ti-Hao
authors.initials: TH
authors.lastname: Wang
authors.forename: Yuan-Hao
authors.initials: YH
authors.lastname: Lo
authors.forename: Kuan-Ting
authors.initials: KT
authors.lastname: Hou
authors.forename: Justin Ging-Shing
authors.initials: JG
authors.lastname: Won
authors.forename: Tjin-Shing
authors.initials: TS
authors.lastname: Jap
authors.forename: Chin-Sung
authors.initials: CS
authors.lastname: Kuo
mesh_terms: D018268:Adrenocortical Carcinoma / Q000097:blood / Q000150:complications* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000368:Aged; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006929:Hyperaldosteronism / Q000097:blood / Q000150:complications* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D007008:Hypokalemia / Q000097:blood / Q000150:complications* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D014057:Tomography, X-Ray Computed
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone